Provider Demographics
NPI:1710454632
Name:POLISHED PEARLS COUNSELING AND COACHING SERVICES PLLC
Entity Type:Organization
Organization Name:POLISHED PEARLS COUNSELING AND COACHING SERVICES PLLC
Other - Org Name:POLISHED PEARLS COUNSELING AND COACHING SERVICES PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-455-8710
Mailing Address - Street 1:211 NORTH ST W
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3036
Mailing Address - Country:US
Mailing Address - Phone:252-455-8710
Mailing Address - Fax:
Practice Address - Street 1:211 NORTH ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3036
Practice Address - Country:US
Practice Address - Phone:252-455-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487050126Medicaid